ESPN 50th Annual Meeting

ESPN 2017


 
Kidney Re-Transplantation During Childhood-Feasibility and Outcomes
NADEESHA L MUDALIGE 1 ANNA ADAMUSIAK 2 PANKAJ CHANDAK 2 GRAINNE WALSH 1 HELEN E JONES 1 FRANCIS CALDER 2 MARTIN DRAGE 2 CHRISTOPHER CALLAGHAN 2 JONATHON OLSBURGH 2 GEOFF KOFFMAN 2 NICOS KESSARIS 2 NIZAM MAMODE 2 JELENA STOJANOVIC 1

1- EVELINA LONDON CHILDREN’S HOSPITAL
2- GUYS HOSPITAL, LONDON
 
Introduction:

 Kidney transplantation (Tx) has been increasing in small children. This may lead to more children needing 2nd Tx during childhood. This study looked into the characteristics of renal transplant recipients who underwent more than 1 Tx during childhood.

Material and methods:

Single centre retrospective analysis of all paediatric kidney transplants during 2003-2015.

Results:

One hundred and seventy one transplants were performed, nine of which were re-transplants (5.3%). At last follow up (median 8years; IQR 10years), there was no difference in graft survival for children with a single Tx compared with those re-transplanted (p=0.255). Of the re-transplanted patients, eight had two and one had three transplants (80% deceased donors at 1st Tx; 50% at 2nd Tx). Recurrent acute rejections caused graft failure in four patients, 2 had chronic AMR, 2 thrombosis and one FSGS recurrence. All patients were CMV and EBV naive at 1st Tx. Two patients have previously undergone Tx onto aorta/IVC and had a re-transplant to the same vessels. Five were HLA sensitized, one highly (cRF>85%). The difference in graft survival at 3 year follow-up between first and second transplant was not significant (98% and 88% respectively; p=0.2). Three patients lost 2nd graft before adulthood due to chronic AMR and BKVAN, one of which received 3rd Tx at the age of 8 years.

Conclusions:

The re-transplantation rate is low in this cohort. Despite surgical and immunological challenges kidney re-transplantation in childhood is feasible and with good outcomes; this should be accounted for when consenting and determining the management for young recipients.